By Stephanie Brooks, MS, RD, CEDRD
I have the honor of working with some wonderful families from a nutrition therapy standpoint. Fairly often, I get a call or email from a parent who is worried about their child’s weight being either ‘too much’ or ‘too little.’ This worry often stems from a physician’s, family member’s, neighbor’s or other well-intentioned person’s comment about the child’s weight or size. The weight comments are typically under the guise of health or fear of the child being teased. This is weight stigma at work.
When I meet with parents tears are all too often. Parents have tremendous worry and guilt about their kid’s weight size. Society puts a lot of pressure on parents for a lot of stuff. Feeding children ‘properly’ is on most people’s radars.
Part of the problem is that there are sooo many opinions about what is best for kids, and information is contradictory. But that’s a topic in and of itself and is fodder for another article.
We assume and we judge
Now no one wants kids to suffer or go without. The big problem is we make HUGE assumptions based upon size. We assume a small or thin kid isn’t being fed well and may not develop properly. We assume a fat kid is eating only junk, not moving, and will get type 2 diabetes. Judgement is passed that the parents aren’t doing a good job and that the child’s body isn’t a good enough body or is just wrong.
We push food on the thin kid and restrict food from the fat kid
Well-intentioned parents will often react out of fear and try to push food on the thin kid and restrict food from the fat kid. What we know is that the more food parents push on a child, the less the child eats and when parents restrict food, the child hoards food, sneak eats and/or over eats when opportunity rises.
If you think about how we tend to respond to pressure, it makes total sense. When we are pushed, we push back. It’s how we react, it’s an unconscious protective response.
The result–dysregulated eating
The result of these well-intended efforts are kids who have dysregulated eating patterns and behaviors and outright eating disorders.
So what do we do?
First we need to stop and breathe.
Face the facts and your fears
Then we need to really look at what we know is true and acknowledge what we don’t know. And really look at where our fears originate, what ‘stories’ we’ve been told and hold onto.
We know that:
- Weight isn’t a useful proxy to determine health in adults or children. Some folks are just designed to be bigger or smaller. Think bell shaped curve.
- There is evidence that dieting and unhealthy weight control behaviors in teens results in higher weights, greater incidence of bingeing and disordered eating.
- Weight bias favoring thinner bodies, media exposure, and appearance based conversations amongst five year old, yes you read that right, five year old girls correlated with dietary restraint. What business does a five year old have to do with dieting?! Developing brains and bodies need nutrition. Aaakk!
- We have no ‘cure’ for obesity and no effective means for sustainable weight loss in adults and even less data about kids.
- We don’t have data showing that weight loss improves health status. We do have data that shows eating well, moving, getting good sleep and having a support system improves or sustains health status.
- There are12 incidences of Type 2 diabetes/100,000 children and 2,900 incidences of eating disorders/100,000 children.
- Children who are overweight and obese are at greater risk for bullying.
- Teens who are obese are at significant risk of developing an eating disorder. Since they are in a higher weight range their symptoms often go unrecognized and untreated.Leading to greater degrees of malnutrition and poorer prognosis for recovery.
You can learn about the latest research, treatment approaches and trends at The BEDA 2015 National Conference:
The damage weight stigma does
You may think, but those are a bunch of numbers and data, it doesn’t really effect everyday people. I wish you were right, but the truly sad part is I see the aftermath of weight stigma on normal every day kids and adults every day in my office. I see the depression, distress, and isolation of body shame. I see the deadly and harmful effects of disordered eating and exercise behaviors. I see the destruction of individuals and families from this nasty disease.
And you know what, it’s got to stop.
Stop weight stigma
We need to do no harm. Our weight loss interventions that we have today are not effective and worse, cause harm. Our current messages and campaigns about ‘health’ and childhood obesity stigmatize fat kids and leave thin and normal-sized kids thinking, “I can eat what I want and not worry about it” and “OMG! I have to do whatever I can to not EVER become fat. These anti-obesity messages don’t help with developing competent, normal eaters who feel good about themselves and their bodies and thereby want to take good care of themselves.
Stop anti-obesity messages
Now as a dietitian who specializes in families and eating disorders I do believe there is a place for nutrition education and support. I believe that ALL children, regardless of size, deserve to have good nutritious foods, a safe place to play and live and access to a good education and health care. There are often barriers to families being able to access quality food, safe living environments, education and healthcare. Removing the barriers will be much more effective in improving kid’s health. From the information above, there are far fewer kids developing type 2 diabetes than eating disorders. I worry if we keep our current messages about childhood obesity going, then we will have even more kids with eating disorders and what will that ‘cost’ us as a society?
Start changing “the talk”
For families who do come see me, I spend time working with them to develop good feeding dynamics for the entire family, providing nutrition education and support as needed, teaching parents how to interpret if there really is a growth problem, helping families change the ‘talk’ and focus from size to much more supportive talk and actions. It is a relief for some and can go somewhat smoothly.
Start losing the weight bias
For others it can be really challenging. I find the families who tend to have the most difficulty doing this type of work tend to have the most weight bias. I would love it if one day I was put out of business because there was no body shame or destructive eating practices. That would be a day totally worth celebrating. So, if you can, please do your part to put me out of business.
For some good information and direction about nutrition and kids I recommend any book by Ellyn Satter, for good information about body confidence I recommend anything by Kathy Kater.
 Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index Neumark-Sztainer, D., Wall, M., Story, M., Standish, A. January 26, 2011 – Source: Journal of Adolescent Health 50 (2012) 80–86
 Dietary restraint of 5-year-old girls: Associations with internalization of the thin ideal and maternal, media, and peer influences. Damiano SR 1, Paxton SJ 1, Wertheim EH 1, McLean SA 1, Gregg KJ 1. (Int J Eat Disord 2015).
 Writings Group et al., “Incidence of Diabetes”
 K.R. Merikangas et al., “Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement, ” Journal of the American Academy of Child and Adolescent Psychiatry 49,no. 10 (2010): 980-9.
More about Stephanie
Stephanie Brooks has been practicing as a registered dietitian since 1991. She earned her BS in nutrition and clinical dietetics from UC Berkeley, her MS in nutrition and food science from San Jose State University, her certificate in eating disorders from John F. Kennedy University in 2003 and . Stephanie founded Bay Area Nutrition, LLC in 1999, a nutrition practice providing individuals, families and groups with the most up to date and user friendly nutrition information and guidance. Stephanie is a nationally recognized expert in the field of disordered eating and pediatric feeding problems. Stephanie also provides training and supervision for nutrition and other professionals. She is passionate about her work and loves to see the ‘ah-ha’ moments when clients start to feel better, have more energy, improve health and fine the right balance for them. She practices a “Health at Every Size (HAES)” philosophy and utilizes a “non-diet/mindful” approach to eating, activity and life balance when appropriate. Stephanie is a published author and speaker often speaking to professionals, school and community groups and corporations.
Stephanie is a member of the following organizations:
The Academy of Nutrition and Dietetics
California Dietetic Association
Academy for Eating Disorders (AED)
Association for Size Diversity and Health (ASDAH)
Binge Eating Disorder Association (BEDA)
NEDA (National Eating Disorders Association)
San Jose Peninsula Dietetic Association
Pediatric Nutrition Dietetic Practice Group
Sports and Cardiovascular Dietetic Practice Group
International Association of Eating Disorder Professionals- treasurer of SF Bay Area Chapter Eating Disorder Resource Center